HomeMy WebLinkAboutPermit Fence 1993-05-26C'TY OF OREGO'U
FENCE PBRHIT APPTICATION
CITY OF SPRINGFIBLD
BUILDING SAFETY DIVISION
State:
SPFlINGFIELO
0ffice:
INSPECTION LINE:
225 North Fifth Street
Springfield, Oregon 97477
Job Location:
Assessors Map *:
0vner:
Addres
Ci
726-3759
7 26-37 69
Tax Lot *:
Phone #:
Zipz
l-Value of Fence:Fence Permit is $5.00
Contrac tor/Ins tal1er :
Address:Phone #:
Ci ty:State:zip:
Construction Contractors Registration *:Expires:
By signing this permit/application, I agree to caII for an inspection once my
fence has been constructed (726-3769), I also stated that all information onthis applieation/permit is correct and that I vas provided vith the Springfield
Development code requirements for fence standards.
ture Date
FOR OFFICE USE
Date of Application:JOB *:
u)
aReceipt #
Total Amount Collected:
Issued By
Checked f or Delinqttene'i es :Checked for Historieal. Status:
Permit No:4bo
Address:
lssued by
\gt s g
b-uq^
2
OR OFFICE USE ONLY
STATEMENT:
INFORMATTON NOTICE TO PROPERTY OWNERS
ABOUT CONSTRUCTION RESPONSIBILITIES
Note: Oregon Law, ORS 701.055(4) , requires residential construction permit
applicants who are not registered with the Construction Contractors Board to
sign the following statement before the building permit can be issued. This state-
ment is required for residential building, electrical, mechanical, and plumbing
permits. Licensed Architect and Engineer applicants, exempt from registration
under ORS 701.010(7), need not submit this statement. This statement will be
filed with the permit.
Fill in the icable blanks, and initial boxes 1 and 2, and either box 3A or 38
I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold
or offered for sale before or upon completion.
3.A My general contractor is ,
Contractor registration number-
I will instruct my general contractor that all subcontractors who work on the struc-
ture must be registered with the Construction Contractors Board.
3.B I will be my own general contractor.
lf I hire subcontractors, I will hire only subcontractors registered with the Construc-
tion Contractors Board. lf I change my mind and do hire a general contractor, I will
contract with a contractor who is registered with the Construction Contractors Board
and I will immediately notify the office issuing this building permit of the name of
the contractor.
I hereby certify that the above information is correct and that I have read and understand
the lnlormation Notice to Property Owners about Construction Responsibilities on the
reverse side ol this form.
OR
6lu
n ure o pp cant
CONSTRUCTION CONTRACTORS BOARD
0244J 8t91
e
WHITE COPY TO ISSUING AGENCY PERMIT FILE
PINK COPY TO APPLICANT
Date:
1